title: Late-onset agoraphobia: general population incidence and evidence for a clinical subtype.
abstract: OBJECTIVE
  The purpose of this study was to estimate the general population incidence of late-life agoraphobia and to define its clinical characteristics and risk factors.
  
  
  METHODS
  A total of 1,968 persons ≥65 years old were randomly recruited from the electoral rolls of the district of Montpellier, France. Prevalent and incident agoraphobia diagnosed with a standardized psychiatric examination and validated by a clinical panel were assessed at baseline and over a 4-year follow-up.
  
  
  RESULTS
  The 1-month baseline prevalence of agoraphobia was estimated to be 10.4%. Among persons with agoraphobia, 10.9% reported having their first episode at age 65 or above. During the 4-year follow-up, 11.2% of participants without agoraphobia at baseline had a first episode, resulting in an incidence rate of 32 per 1,000 person-years. These 132 incident late-onset cases were associated with higher incidence rates of anxiety disorders and suicidal ideation. Of the incident cases, only two were characterized by past or concurrent panic attacks, a rate that was not significantly different from that of the noncase group. The principal baseline risk factors for incident cases, derived from a multivariate model incorporating all significant risk factors, were younger age at onset (odds ratio=0.94, 95% CI=0.90-0.99), poorer visuospatial memory performance (odds ratio=1.60, 95% CI=1.02-2.49), severe depression (odds ratio=2.62, 95% CI=1.34-5.10), and trait anxiety (odds ratio=1.73, 95% CI=1.03-2.90). No significant association was found with cardiac pathologies.
  
  
  CONCLUSIONS
  Agoraphobia has a high prevalence in the elderly, and unlike cases in younger populations, late-onset cases are not more common in women and are not associated with panic attacks, suggesting a late-life subtype. Severe depression, trait anxiety, and poor visuospatial memory are the principal risk factors for late-onset agoraphobia.
authors.affiliation: French National Center for Health and Medical Research (INSERM), Montpellier, France.
authors.forename: Karen
authors.initials: K
authors.lastname: Ritchie
authors.forename: Joanna
authors.initials: J
authors.lastname: Norton
authors.forename: Anthony
authors.initials: A
authors.lastname: Mann
authors.forename: Isabelle
authors.initials: I
authors.lastname: Carrière
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Ancelin
mesh_terms: D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000379:Agoraphobia / Q000145:classification / Q000150:complications / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007406:Interview, Psychological; D008297:Male; D016584:Panic Disorder / Q000453:epidemiology / Q000209:etiology; D015995:Prevalence; D012307:Risk Factors